Brief 003 · Understand · source checked 2026-07-31
Deductible, copay, coinsurance: what each changes.
A four-frame glossary for three different forms of cost sharing—and the narrower rules around an out-of-pocket limit.
Answer first
The short version
A deductible is what you pay for covered services before the plan starts paying under its rules; a copay is a fixed amount for a covered service; coinsurance is a percentage of a covered service's cost. Your plan documents control when each applies and what counts toward the out-of-pocket limit.
- Deductibles, copays, and coinsurance are different forms of cost sharing.
- A plan may cover some services before the deductible, so check the plan document.
- Premiums, out-of-network care, and non-covered services generally do not count toward the in-network out-of-pocket limit.
Frame 1 of 4: Deductible
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Deductible
A deductible is the amount a person pays for covered services before a health plan starts to pay. Some plans cover certain services before the deductible, so the plan document controls.
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Full transcript
- 01
Deductible
A deductible is the amount a person pays for covered services before a health plan starts to pay. Some plans cover certain services before the deductible, so the plan document controls.
- 02
Copayment
A copayment is a fixed amount for a covered service, often paid when the service is received. The amount can vary by service and plan.
- 03
Coinsurance
Coinsurance is a percentage of the cost of a covered service that the member pays. HealthCare.gov’s glossary describes it as commonly applying after the deductible is met.
- 04
Out-of-pocket limit
The limit applies to a plan year and to covered in-network care under the plan’s rules. Premiums, out-of-network care, and non-covered services generally do not count toward it.
Common questions
Quick answers from this brief
What is the difference between a copay and coinsurance?
A copay is a fixed amount for a covered service. Coinsurance is a percentage of the covered service's cost, commonly after the deductible is met.
Does everything I pay count toward the out-of-pocket limit?
No. Premiums, out-of-network care, and non-covered services generally do not count. Your plan documents govern the specific rules.
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- MedicalRecords.com Editorial
- Published
- 2026-07-31
- Source check
- 2026-07-31
- Page updated
- 2026-08-12
- Format
- 4-frame visual brief + transcript
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